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L3 (1ST BMEX) > OB5 > Flashcards

OB5 Flashcards

1
Q

Which of the following changes are not part of the physiological changes in a pregnant woman?

A. Blood increased by 450 ml/min in mid-trimester
B. Maternal hemorrhage averages 40-45% more than pre-pregnant state after 32-34 weeks AOG
C. Moderate erythroid hyperplasia develops in the bone marrow
D. More erythrocytes than plasma are added to the maternal blood circulation

A

D. More erythrocytes than plasma are added to the maternal blood circulation

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2
Q

An 18 y/o G1P1 (1001) delivered a live baby boy weighing 2.3 kg after an 8-hour labor. 30 minutes after placental delivery, profuse vaginal bleeding was noted. The effect of hemorrhage on this patient is dependent on this risk factor

A. Maternal pregnancy blood volume
B. Pregnancy induced hypervolemia
C. BMI
D. Length of labor

A

B. Pregnancy induced hypervolemia

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2
Q

Which of the following groups of pregnant women is not susceptible to postpartum hemorrhage?

A. Obese
B. Preeclamptic
C. With chronic renal failure disease
D. Eclamptic

A

NONE

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3
Q

A 26 yo G1P0 came in for hypogastric pain. FH is 38 cm and ultrasound revealed multifetal pregnancy cephalic/cephalic presentation. She was brought immediately to the delivery room since she was already bearing down and is 8 cm dilated. 2 hours after, same IE was noted and thus was scheduled for CS. After the delivery of the placenta, profuse bleeding and boggy uterus was noted. Which of the following is not a risk factor for her case?

A. Primiparity
B. Overdistended uterus
C. Augmented labor
D. Labor dystocia

A

Dx: Uterine Atony
C. Augmented labor

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3
Q

In a primigravid patient who had uterine atony after delivery, several uterotonics were already given but the uterus is still boggy, which surgical procedures cannot be done on her?

A. B-Lynch compression
B. Internal iliac artery ligation
C. Augmentation
D. Hysterectomy

A

C. Augmentation

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4
Q

A G3P2 delivered a live baby girl weighing 3.5 kg. 1 hr after postpartum care, the patient complained of an excruciating pain on her vulva and has difficulty in voiding. On physical exam, intact episiotomy was noted but a 5x4 cm fluctuant tender mass was noted in the left lateral portion at the 9 o’clock position of the middle third of the vagina. Which should be done to this patient?

A. Expectant management
B. Surgical exploration
C. Interventional embolization
D. Ice packing

A

B. Surgical exploration

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4
Q

A multigravida delivered spontaneously at home. After delivery, a scaphoid abdomen and a red fleshy mass was noted at the perineal area. What is the cause of this condition?

A. Cord traction after delivery of the placenta
B. Tetanic contraction
C. Placenta in fundal area
D. Precipitous delivery

A

C. Placenta in fundal area

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5
Q

A G2P1 (1001), hypogastric pain. FH 38 cm. IE cervix 6 cm, cephalic -1. Intact membranes bulging. Sudden rupture of membranes after IE. What condition will this patient be predisposed to?

A. Placenta previa
B. Uterine atony
C. Abruptio placenta
D. Uterine invasion

A

A. Placenta previa

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5
Q

Which of the following conditions is not associated with abruptio placenta?

A. Asherman’s syndrome
B. DIC
C. Couvelaire uterus
D. AKI

A

A. Asherman’s syndrome

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6
Q

A G3P2 (2002) at 32 weeks came in for abdominal pain. FH 32 cm FHT (-). IE 3 cm 30% effaced and had stained port wine amniotic fluid. What is the best management?

A. Vaginal delivery
B. Cesarean delivery
C. Partial breech extraction
D. Total breech extraction

A

A. Vaginal delivery

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6
Q

Tetanic contractions were noted in a multigravida patient at 38 weeks. IE was 3 cm, 30% effaced, cephalic -3, intact membranes. Amniotomy revealed port wine discoloration of the amniotic fluid. Oxytocin was infused to the ongoing fluid. What is the rationale of adding oxytocin?

A. Hasten delivery
B. Decrease implantation site bleeding
C. Reduce thromboplastin infusion to the maternal circulation
D. Coordinate the uncoordinated uterine contractions

A

D. Coordinate the uncoordinated uterine contractions

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7
Q

A G2P1 (1001) came in due to vaginal bleeding at 28 weeks AOG. On the speculum exam, fetal vessels were noted at the cervical os. What is the most likely diagnosis?

A. Placenta previa
B. Abruptio placenta
C. Vasa previa
D. Partial mole

A

C. Vasa previa

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7
Q

A G3P2 (2002) 30 weeks AOG came for consult complaining of painless vaginal bleeding which soaked her underwear. What is the cause?

A. Placenta abruptio
B. Amniotic fluid embolism
C. Placenta previa
D. Vasa previa

A

C. Placenta previa

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8
Q

A multigravida had an ultrasound finding of placenta previa at 36 weeks AOG. All her previous pregnancies were delivered vaginally. She has no history of previous bleeding. Which of the following would give an imprecise result in this condition on the ultrasound?

A. Distended bladder
B. Large posterior placenta
C. Well-developed placenta
D. Small fundal placenta

A

A. Distended bladder

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8
Q

A 35-week AOG patient came in due to vaginal spotting for 3 days and then bleeding suddenly stopped. What is the appropriate mode of delivery on a 37-38 weeks AOG patient?

A. Vaginal delivery
B. Low segment CS
C. Classical CS
D. Fundal CS

A

C. Classical CS

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9
Q

Which of the following conditions would most likely benefit from peripartum hysterectomy?

A. G5, 38 yo, 37 weeks AOG, CS due to fetal distress, couvelaire uterus noted intraoperatively
B. G5, 38 yo, 37 weeks, previous classical CS 1x due to transverse lie, anterior placenta previa on ultrasound
C. G5, 38 yo, 37 weeks, S/P curettage, CS due to fetal distress
D. G5, 38 yo, 37 weeks, S/P myomectomy, posterior placenta on ultrasound

A

B. G5, 38 yo, 37 weeks, previous classical CS 1x due to transverse lie, anterior placenta previa on ultrasound

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10
Q

The underlying cause of placenta accreta

A. Absence of Nitabuch’s layer
B. Thickened decidua basalis
C. Incomplete development of the fibrinoid layer
D. Thickened spongy layer

A

C. Incomplete development of the fibrinoid layer

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11
Q

A multipara pregnant woman 37 weeks AOG had an ultrasound having posterior placenta previa. She has a history of 1 CS and 1 curettage. What is the recommended mode of delivery?

A. Low transverse CS
B. CS hysterectomy
C. Classical CS
D. Internal artery ligation

A

C. Classical CS

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12
Q

G1P0 at 37 weeks AOG came in due to soaking napkins. She was diagnosed at 34 weeks AOG with placenta previa totalis. Emergency CS done. After placenta delivery, there was profuse vaginal bleeding. Which should less likely be done?

A. Giving uterotonics
B. Oversew placenta site
C. Tightly pack lower uterine segment with gauze
D. Hysterectomy

A

D. Hysterectomy

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12
Q

Which of the following patients has a higher risk of having placenta accreta in a patient with placenta previa at 34 weeks AOG?

A. Hx of 1 curettage
B. Hx of 1 low transverse CS
C. Hx of classical CS
D. Hx of myomectomy

A

C. Hx of classical CS

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13
Q

Consumptive coagulopathy is not associated with this condition

A. Placenta abruptio
B. Amniotic fluid embolism
C. Placenta previa
D. Exotoxin by gram-positive bacteria

A

C. Placenta previa

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14
Q

In a multigravida patient who had postpartum hemorrhage, which of the following vital signs is the most important to monitor?

A. Blood pressure
B. Respiratory rate
C. Heart rate
D. Urine output

A

D. Urine output

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14
Q

This type of blood is given to patients with DIC

A. Whole blood
B. Packed RBC
C. FFP
D. Platelet concentrates

A

C. FFP

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15
Q

Uterine rupture from a previously intact uterus during labor involves the

A. lower uterine segment
B. midsegment
C. fundal segment
D. posterior segment

A

A. lower uterine segment

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15
Q

Midtrimester bleeding between 22-28 weeks are attributed mostly to the following except

A. Placenta abruption
B. Trauma
C. Placenta previa
D. Cervical bleeding

A

B. Trauma

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16
Q

Partial or complete avulsion of the cervix from the vagina

A. Colpotomy
B. Colporrhexis
C. Colporrhaphy
D. Culdocentesis

A

B. Colporrhexis

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16
Q

Least common presentation of patients who have abruptio placenta

A. Sudden onset abdominal pain
B. Painless vaginal bleeding
C. Uterine tenderness
D. Non reassuring fetal status

A

B. Painless vaginal bleeding

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16
Q

Elevated serum level of this marker is highly suggestive of abruptio

A. Alpha fetoprotein
B. Beta HCG
C. CA 125
D. CA 19-9

A

A. Alpha fetoprotein

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17
Q

Pituitary failure after a postpartum hemorrhage

A. Sheehan’s syndrome
B. Simmond’s syndrome
C. Asherman’s syndrome
D. Couvelaire’s syndrome

A

A. Sheehan’s syndrome

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18
Q

A cause of uterine rupture due to coincidental uterine trauma

A. CS or hysterectomy
B. Previous repair from uterine rupture
C. Myomectomy incision through or to the endometrium
D. Silent rupture from previous pregnancy

A

AOTA

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19
Q

A disruption of normal hemostasis due to massive loss of procoagulants during massive hemorrhage

A. Consumptive coagulopathy
B. Dilutional coagulopathy
C. Preemptive coagulopathy
D. Normal coagulopathy

A

B. Dilutional coagulopathy

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20
Q

Priority in the management of consumptive coagulopathy

A. Removal of the cause
B. Use of antifibrinolytic agent
C. Blood transfusion
D. Use of crystalloids and colloids

A

A. Removal of the cause

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21
Q

The diagnostic criteria for amniotic fluid embolism does not include this

A. Hypotension and respiratory arrest
B. Clinical onset within 30 minutes after placental delivery
C. Absence of fever
D. Rapid labor

A

D. Rapid labor

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21
Q

Cervical mucus method is a form of contraception that involves

A. Fertility is based on the quantity of cervical mucus
B. Increased mucus is associated with progesterone
C. A dry and scanty mucus is due to estrogen
D. Abstinence is advised at the peak of mucus production

A

A. Fertility is based on the quantity of cervical mucus

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21
Q

According to the US Medical Eligibility Criteria for Contraception, which is the most highly contraceptive method for hypertensive women with adequately controlled hypertension?

A. Depomedroxyprogesterone acetate 2nd
B. Combined oral contraceptives 3rd
C. Implants
D. Fertility-based awareness method

A

C. Implants

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22
Q

In a patient with current pelvic inflammatory disease, the US MEC recommends the following contraception

A. Copper IUD
B. Levonorgestrel IUD
C. Implants
D. Barrier methods

A

C. Implants

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23
Q

Which of the following contraceptive methods when used for a prolonged period is associated with cervical cancer?

A. Implants
B. Progestin only pill
C. IUD
D. Combined oral contraceptive

A

D. Combined oral contraceptive

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23
Q

The MOA of lactation amenorrhea

A. Makes the cervical mucus scanty
B. Suppresses menses
C. Decreased GnRH
D. Increased FSH, LH

A

B. Suppresses menses

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23
Q

What contraceptive causes weight gain?

A. DMPA
B. Implant
C. IUD
D. Combined oral contraceptives

A

D. Combined oral contraceptives

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24
Q

Complete release of sperm stored in the reproductive tract beyond the interrupted vas deferens takes approximately

A. 20 ejaculations
B. 10 ejaculations
C. 15 ejaculations
D. 5 ejaculations

A

A. 20 ejaculations

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24
Q

The main effect of LNG-IUS is found in which part of the female reproductive system?

A. Ovary
B. Endometrium
C. Fallopian tube
D. Cervix

A

B. Endometrium

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25
Q

A G3P2 (2002) with IUD came in for amenorrhea. Urine pregnancy test showed a positive result. What is the next thing to do?

A. Get a transvaginal ultrasound to confirm the pregnancy
B. Insert a speculum to locate the string for immediate removal
C. Schedule for a hysterectomy
D. Leave the IUD in place for possible spontaneous expulsion

A

A. Get a transvaginal ultrasound to confirm the
pregnancy

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26
Q

The hormone in combined oral contraceptives responsible for the cervical mucus changes

A. Progestins
B. Ethinyl estradiol
C. Mestranol
D. Progesterone

A

A. Progestins

26
Q

A 49 y/o multigravida patient asks about contraceptive use. She was using pills for 5 years but was scared by what her neighbors said that it can cause breast cancer. The patient still wants to use contraceptives to avoid a menopausal baby, what will you recommend?

A. Rhythm
B. IUD
C. DMPA
D. Low dose OCP

A

B. IUD

27
Q

A primigravida came in for follow-up a week after delivery, and asked for contraceptive methods. Which of the following is least recommended to this patient who is breastfeeding her baby?

A. POP
B. IUD
C. DMPA
D. Rhythm method

A

D. Rhythm method

27
Q

Female sterilization as a contraceptive method involves the following

A. Entails removal of uterus and adnexa
B. Puerperal timing of BTL employs use of rings and clips
C. One of its therapeutic indication is prevention of ovarian cancer
D. May increase libido and sexual desires in women

A

C. One of its therapeutic indication is prevention of ovarian cancer

28
Q

Male sterilization involves the following

A. Sterilization is not immediate
B. Protects against sexually transmitted diseases
C. Female partners are going to use contraceptives for 6 months
D. Prevents testicular cancer

A

A. Sterilization is not immediate

29
Q

A 20-year-old G1P1 was wheeled into the recovery room minutes after a normal vaginal delivery following a prolonged labor. Which of the following is correct about postpartum care in this patient?

A. For two hours, anti-embolic stockings are recommended.
B. For one hour after delivery BP and RR are taken every 15 minutes.
C. For two hours, the urine output is measured hourly.
D. For one hour, the uterus is monitored closely for uterine atony.

A

D. For one hour, the uterus is monitored closely for uterine atony.

30
Q

A 29-year-old primigravid is induced at 42 weeks gestation. She is having intermittent abdominal pain when the prostaglandin is inserted. One hour later she is transferred to the delivery suite in extreme pain and 20 minutes later she delivers a 3.8 kg baby boy rapidly followed by the placenta. The possible risk factors for postpartum hemorrhage in the complex scenario is:

A. Uterine overdistention
B. Precipitate labor
C. Atony
D. Vulvar hematoma

A

C. Atony

30
Q

Which artery is most often associated with vulvar hematoma?

A. Uterine
B. Femoral
C. Cervical
D. Pudendal

A

D. Pudendal

30
Q

During internal iliac artery ligation, what is the best part to ligate to avoid compromising the areas it supplies:

A. Anterior
B. Posterior
C. Ventral
D. Caudal

A

D. Caudal

31
Q

Which of the following is the most common sign of uterine rupture?

A. Loss of station
B. Abdominal tenderness
C. Profuse vaginal bleeding
D. Non-reassuring FHR

A

D. Non-reassuring FHR

31
Q

A few minutes after delivering a 3.8 kg baby, a 38-year-old, G4P4(4004) has profuse vaginal bleeding. Examination reveals a soft, boggy uterus. BP is at 90/60, heart rate 120 bpm, respiratory rate of 24. You give carbetocin along with bimanual massage with no improvement. What is the next best step?

A. Uterine packing
B. Total hysterectomy
C. Devascularization
D. B-lynch compression suture

A

A. Uterine packing

32
Q

The clinical signs and symptoms of restlessness, pallor and oliguria are usual manifestations of a patient with blood loss approximately:

A. 500-1000 ml
B. 1000-1500 ml
C. 1500-2000 ml
D. 2000-2400 ml

A

C. 1500-2000 ml

32
Q

In the absence of contraception, what percentage of fertile sexually active women will conceive within a year?

A. 50
B. 90
C. 75
D. 40

A

B. 90 Not sure
Around 85 percent

32
Q

Following delivery of the placenta, which of the following is contraindicated?

A. 20 U of Oxytocin in 1000 mL Ringer’s lactate solution
B. Methergine intramuscularly
C. Uterine massage
D. 20 U Oxytocin Intravenous bolus

A

D. 20 U Oxytocin Intravenous bolus

32
Q

The most common cause of postpartum hemorrhage mandating hysterectomy.

A. Placenta accrete
B. Uterine atony
C. Placenta previa
D. Irreparable vaginal tears

A

C. Placenta previa

33
Q

One hour postpartum, a multigravida patient complaint of an excruciating pain on her vulva. On inspection, a 5 x 4 cm tender erythematous mass was noted on the left side of her vulva. What should be done on this patient?

A. Incision and drainage
B. Surgical exploration and ligation of bleeders
C. Ice pack
D. Expectant

A

B. Surgical exploration and ligation of bleeders

33
Q

A healthy 30-year-old G2P2(2002) was seen at the Family Planning Clinic 2 weeks after she delivered a stillborn baby. She has no vices and wants to use combined oral pills. When is the earliest time that you can start the pills?

A. Wait for one more week later
B. On the first day of her menstrual cycle
C. Six weeks after her delivery
D. Four weeks after delivery

A

A. Wait for one more week later

33
Q

Which of the following is not true of PROGESTIN only contraceptive pills?

A. Inhibit ovulation reliably
B. Impede blastocyst implantation
C. Alter endometrial maturation
D. Alter cervical mucus

A

A. Inhibit ovulation reliably

34
Q

Progress of labor of a 32-year-old G1PO has been unremarkable for the past 6 hours. At six cm cervical dilatation, amniotomy was done. Egress of bloody fluid with sudden fetal bradycardia was noted. What is the most probable diagnosis?

A. Abruptio placenta
B. Uterine rupture
C. Vasa previa
D. Placenta previa

A

C. Vasa previa

35
Q

A 32-year-old G2P.1(1001), 34 weeks AOG, has had vaginal bleeding for the past 2 hours. History revealed that she had a similar episode 2 weeks ago for which no consult was done since bleeding stopped spontaneously. She has stable vital signs. Baby is in breech presentation with estimated fetal weight appropriate for gestational age and with good FHT. What should be the next step?

A. Transvaginal ultrasound
B. Abdominal delivery
C. Start tocolysis
D. Speculum examination

A

A. Transvaginal ultrasound

35
Q

What is the most appropriate management of vulvovaginal hematomas?

A. If bleeding ceases, small to moderate-sized hematomas can be treated expectantly.
B. To prevent infection they should all undergo ultrasound guided drainage.
C. Surgical exploration in all cases
D. In a small hematoma, if pain is severe, then ice packs and analgesia are appropriate.

A

A. If bleeding ceases, small to moderate sized hematomas can be treated expectantly.

36
Q

It is an obstetrical event where defibrination syndrome is noted.

A. Consumptive coagulopathy
B. End organ damage
C. Anaphylaxis
D. Hypovolemic shock

A

A. Consumptive coagulopathy

36
Q

Which of the following drugs decrease the effectiveness of oral contraceptives?

A. Aspirin
B. Erythromycin
C. Rifampicin
D. Propranolol

A

C. Rifampicin

36
Q

Oral contraceptives have not been associated with which of the following?

A. Increase pigmentation of face
B. Depression at higher doses of estrogen
C. Increase rate of HIV infection
D. Improvement of acne

A

C. Increase rate of HIV infection

36
Q

A method of tubal ligation where a midsegment tubal loop is made and ligated, plain cutgut is then used to ensure prompt absorption of the ligature and separation of the severed tubal ends are done.

A. Uchida
B. Fimbriectomy
C. Pomeroy
D. Parkland

A

C. Pomeroy

37
Q

A 27-year-old G2P1(1001), 35 weeks AOG consults for profuse vaginal bleeding associated with mild uterine contractions. BP is 80/50, HR 108, RR 20. Fundic height is 30cm, EFW 2.2-2.4 kg, FHT 130. What is the next best thing to do?

A. Send patient to ultrasound
B. Prepare for emergency CS
C. Start tocolysis
D. Do internal examination

A

B. Prepare for emergency CS

37
Q

Which of the following is positively associated with oral contraceptive use?

A. Malignant liver disease
B. Thromboembolic events
C. Ovarian cancer
D. Retinopathy

A

B. Thromboembolic events

38
Q

Couple is being given advise about the proper use of condoms. Which of the following statements is correct?

A. Use an oil-based lubricant to make penis intromission friction-free
B. Wear the condom when ejaculation is imminent
C. Withdraw the condom while penis is still erect
D. Breakage of nonoxonyl-9 lubricated condom won’t lead to pregnancy

A

C. Withdraw the condom while penis is still erect

38
Q

Lactation amenorrhea is least likely applicable in which condition?

A. Mother has not started menses.
B. Mother must breast feed day and night.
C. Baby is more than 6 months old.
D. Infant must receive at least 85% of feeding as breastfeeding.

A

D. Infant must receive at least 85% of feeding as breastfeeding. (Not mentioned)

38
Q

A 32-year-old G1P1(1001) underwent forceps delivery an hour ago. At the recovery room, she develops hypotension and tachycardia. On examination, her uterus is contracted with no adnexal mass or tenderness. What is the most probable diagnosis?

A. Uterine atony
B. Retained products of conception
C. Genital tract lacerations
D. Uterine rupture

A

C. Genital tract lacerations

39
Q

What is the rationale for amniotomy in cases of abruptio placenta?

A. Reduce entry of thromboplastin to the maternal circulation.
B. Hasten delivery.
C. Stop further separation of the placenta.
D. Decrease bleeding from the implantation site

A

A. Reduce entry of thromboplastin to the maternal circulation.

39
Q

The mother of a 17-year-old G1P1 presented a DEXA scan of her daughter showing bone loss. She wants her to continue DMPA for its convenience of use but was afraid about bone loss in DMPA users especially among adolescents. What is the proper thing to do?

A. Continue DMPA just to complete 5 years
B. Discontinue DMPA and shift to progestin-only pills
C. Continue DMPA as bone loss is reversible
D. Discontinue DMPA and shift to the combined hormonal contraceptives

A

C. Continue DMPA as bone loss is reversible

40
Q

Most common cause of uterine rupture.

A. Manual manipulation
B. Excessive oxytocin
C. Separation of a previous Cesarean Section scar
D. Previous uterine perforation

A

C. Separation of a previous Cesarean Section scar

40
Q

Which of the following estrogen is commonly used in oral contraceptives?

A. Equilin
B. Ethinyl estradiol
C. Estrone
D. Estriol

A

B. Ethinyl estradiol

40
Q

A 34-year-old term multigravid was rushed to the delivery room due to profuse bleeding from a placenta previa. Blood pressure was 70 palpatory. Which of the following would be the appropriate anesthesia for an emergency cesarean section?

A. Epidural anesthesia
B. Subarachnoid block
C. General anesthesia
D. Combined spinal epidural

A

A. Epidural anesthesia

41
Q

Which of the following is not a predisposing factor to postpartum hemorrhage?

A. Prolonged labor
B. Term twins
C. Rapid labor
D. Patient with 1,500gm infant

A

D. Patient with 1,500gm infant

41
Q

What is the most common cause of postpartum hemorrhage?

A. Retained products of conception
B. Uterine rupture
C. Uterine atony
D. Vaginal lacerations

A

C. Uterine atony

41
Q

Which of the following is characteristic of a Couvelaire uterus?

A. Contracts adequately with stimulation
B. Results from excessive oxytocin
C. Requires fibrinogen therapy
D. Requires hysterectomy

A

A. Contracts adequately with stimulation

42
Q

Which of the following is the LEAST effective method of contraception in terms of typical use?

A. Injectable
B. Progestin only pills
C. Combined pills
D. Condom

A

D. Condom

42
Q

An hour after delivery of a twin pregnancy, a preeclamptic patient is diagnosed with uterine atony. Her BP is at 100/80, HR 120. Patient is restless with urine output of 10 cc per hour. What is the stage of hemorrhagic shock?

A. 1
B. 4
C. 3
D. 2

A

C. 3

43
Q

A 21-year-old, G2P2(2002) is interested to learn the use of the rhythm method. She reports that for the past year, her longest cycle was 38 days, while the shortest cycle was 24 days. When should abstinence be observed during her cycle using this method?

A. Day 8-21
B. Day 6-27
C. Day 15-20
D. Day 17-23

A

B. Day 6-27

43
Q

Which of the following condition is not reduced with oral contraceptive use?

A. Cervical cancer
B. Breast milk production
C. Salpingitis
D. Endometrial cancer

A

A. Cervical cancer

43
Q

A G2P1(1001) underwent CS due to malposition. After extraction of the baby, postpartum hemorrhage was noted. On exploration, a 3 cm laceration was noted at the lateral part of hysterotomy incision. To control the hemorrhage, what should be done?

A. Internal Iliac Artery ligation
B. Hypogastric artery ligation
C. Uterine artery ligation
D. B-lynch sutures

A

C. Uterine artery ligation

43
Q

A 29-year-old, G4P4(4004) delivered in a birthing clinic when suddenly on the third stage of labor, after pulling the cord a fleshy mass comes out of the vagina, patient was rushed immediately to a nearby tertiary hospital. What is the most likely diagnosis?

A. Uterine atony
B. Uterine prolapse
C. Uterine inversion
D. Uterine rupture

A

C. Uterine inversion

44
Q

A 25-year-old G3P3(3003) has been taking her low dose combined pills consistently for the past 10 months. She comes to the clinic because she already finished her 28-pill pack last night but has had no menses. What should the health provider advise her?

A. Request for a pregnancy test and ultrasound.
B. Advise her to shift to a new hormone method contraception.
C. Reassure and let her start the next pack at once.
D. Tell her to start the next pack of pills when menses return.

A

C. Reassure and let her start the next pack at once.

45
Q

A 34 years old G2P1(1001), with history of previous cesarean section 4 years ago due to placenta previa, came in for a prenatal check-up. When should you initially request for an ultrasound to identify placental localization?

20 wks AOG
16 wks AOG
28 wks AOG
24 wks AOG

A

20 wks AOG

46
Q

During the fourth stage of labor, the patient should be closely monitored for postpartum hemorrhage most likely due to:

A. Uterine inversion
B.Perineal bleeding
C.Uterine atony
D.Vulvar hematoma

A

C.Uterine atony

47
Q

The best way to avert third stage bleeding is

A. immediate manual extraction of the placenta
B. fluid administration
C. kneading and squeezing of uterus
D.Suturing of lacerations

A

C. kneading and squeezing of uterus

48
Q

G1P0 at 35 weeks AOG consulted in the ER with chief complaint of severe abdominal pain accompanied by moderate vaginal bleeding. Her BP is 180/120 mmHg, PR 88/min, RR 22/min. On palpation of the abdomen the uterus was tetanically contracted and the FHT was faint. The most probable diagnosis is:

A. Placenta previa
B. Uterine Rupture
C.Acute Abdomen
D.Abruption Placenta

A

D.Abruption Placenta

49
Q

The last step in the management of patients with third trimester bleeding

A. Digital cervical exam
B.Uterine contraction monitoring
C.Assessment of maternal vital signs
D.Fetal heart rate monitoring

A

A. Digital cervical exam

50
Q

Hemostasis at the placental site after delivery is LEAST likely achieved in this circumstance.

A. Clotting and thrombosis of blood vessels
B. Retained placental fragments
C.Abnormal coagulation profile
D.Contraction of the myometrium

A

B. Retained placental fragments

51
Q

Mechanism of action of Cu-IUD?

A. Suppression of endometrial proliferation and decidualization of Stroma unsuitable endometrium
B. Increase thickness of cervical mucus
C. Inhibition of sperm transport into the upper genital tract
D.Progestogenic effect on the endometrium

A

C. Inhibition of sperm transport into the upper genital tract

52
Q

What is the cause why patients with placenta previa at risk for uterine atony?

A. The site of implantation has engorged blood vessels during pregnancy
B. This site of implantation is resistant to uterotonic drugs
C. There is only 10% muscle content on the site of implantation thereby uterotonics have decreased effect
D. There are no oxytocin receptors on this area hence uterotonic agents are not effective

A

C. There is only 10% muscle content on the site of implantation thereby uterotonics have decreased effect

53
Q

Histologically, which of the following describes the villi found at placenta increta sites?

A. Attached to the myometrium
B. Invade into the myometrium
C. Penetrate through the myometrium
D. Attached to the endometrium

A

B. Invade into the myometrium

54
Q

Inversion of the uterus almost always follow

A. Traction on the umbilical cord before separation
B. Multiple pregnancy
C. Difficult forceps delivery
D.Abruptio placenta

A

A. Traction on the umbilical cord before separation

55
Q

Women with thyroid peroxidase (TPO) antibodies have an associated increased risk of which of the following?

A. Placenta previa
B. Placental abruption
C.Placenta accreta
D.Preterm rupture of membranes

A

B. Placental abruption

56
Q

What factor or condition during pregnancy can predispose the patient to both uterine atony and abruption placenta?

A. Polyhydramnios
B.Previous cesarean section
C.Fetal macrosomia
D.Fetal malpresentation

A

A. Polyhydramnios

57
Q

This is true with regards the use of IUD

A. First year failure rate is 0.3-0.6%
B.It is both contraceptive and abortifacient
C.The device-related risk of infection is increased only during the first 20 days following insertion
D.IUD replacement for both types is 5 years

A

B.It is both contraceptive and abortifacient

58
Q

A natural family planning method that requires abstinence from the beginning of menses until 4 days after slippery mucus is identified

A. Billing’s
B. Standard days
C. Calendar Rhythm
D. Yuzpe

A

A. Billing’s

59
Q

The major mechanism of DMPA, which accounts for its contraceptive effect is the

A. Production of unfavorable endometrial environment
B. Alteration of cervical mucus
C. Inhibition of the mid cycle gonadotropin surge
D. Alteration of tubal motility

A

C. Inhibition of the mid cycle gonadotropin surge

60
Q

A G5P4(4004) at 39 weeks AOG was in active labor for 3 hours. IE showed cervix 7 cm dilated, fetal head at station 0. Suddenly, fetal heart rate deceleration and maternal blood pressure dropped from 120/80 to 90/60 mmHg. On doing IE, the presenting part appeared to retract. What is the most probably diagnosis?

A. Acute cord traction
B. Spontaneous uterine rupture
C. Abruption placenta
D. Uterine atony

A

B. Spontaneous uterine rupture

61
Q

A G2P2 (2002) consulted for amenorrhea since her delivery. Breastfeeding was not practiced. The last pregnancy was delivered via NSD with history of uterine atony and blood transfusion. What is the most likely cause of her amenorrhea?

A. Ashermann’s syndrome
B. Polycystic ovarian syndrome
C. Simmond’s syndrome
D. Sheehan’s syndrome

A

D. Sheehan’s syndrome

62
Q

Extended IUD use decreases the risk of this carcinoma

A. Liver
B. Breast
C. Ovarian
D. Endometrial

A

C. Ovarian

63
Q

Active management of the third stage of labor includes the following, except
A. Massage the uterus to promote uterine contraction
B. Hysterectomy if with uterine atony
C. Do controlled cord traction to deliver the placenta
D. Give a uterotonic after the placenta has delivered

A

B. Hysterectomy if with uterine atony

L3 (1ST BMEX) (18 decks)

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